Trigger warnings: mental health, depression, anxiety

A friend recently asked me whether I think people need a mental health diagnosis (of depression, anxiety or something else) before they should consider seeking support in the form of therapy. In other words, do I think there is any value for people who are experiencing mental health difficulties, but have not received a formal diagnosis, in accessing support from a therapist or counsellor?

In short, (and I want to shout this from the top of University Place) my answer is yes I absolutely believe there is value in seeking support for mental health difficulties before a diagnosis and no I do not think you need or should wait for a mental health diagnosis before you do so.

But let’s unpack this.

Do you need a diagnosis to be eligible for professional support? Practically speaking, no. In Manchester, people can access NHS mental health services through Self Help. This service offers a wide range of support and services for young people living with mental health difficulties and can be accessed via a GP, online or over the phone, where people can self-refer themselves. Self Help aim to assess people as quickly as possible in order to refer on to an appropriate mental health team and, together, you decide what treatment is best for you. There are also charities that offer therapy and referral (e.g. 42^nd Street is a young people’s charity in Manchester). In addition, staff and students at the University of Manchester can access the counselling service. The point is that none of these services require you to have a formal diagnosis. Support is available to anyone, regardless of whether you have a long-standing mental health problem or are beginning to experience issues for the first time.

However, there is an obvious problem with the above options.  Therapists are a scarce resource and waiting lists for NHS therapy are often long. This is problematic for a number of reasons. If people have built up the courage to take the very brave step to seeking help and are then told there is a long wait, this can be disappointing, distressing and potentially off-putting to following through with it. Their mental health may deteriorate while they wait. Currently, mental health services aim to start people on treatment within four and a half months, but NHS England is working to reduce waiting times by the years 2020-2021. This is why services such as 42^nd street, University counselling and the 24-hour Freephone support from the Samaritans and the Sanctuary are so important.

But what does it mean to receive a diagnosis and how will this benefit you? One school of thought believes that the concept of a diagnosis – that is, a defined, labelled disorder with a fairly fixed (often long) list of symptoms, used to predict a treatment pathway – is not always helpful in the context of mental health. Furthermore, the assumption that psychological distress is best understood as ‘disease’ can have serious consequences for the individual, their identity and their path to recovery, including their outlook on whether recovery is even possible for them. Symptoms are highly variable and criteria change over time. Therefore, mental health disorders often coexist, highlighting the fuzzy boundaries and thresholds we use for diagnosis. In the current model, individuals diagnosed with comorbidities can have less clear or even incompatible treatment options, where some symptoms or experiences are ignored in order to treat others.

Daniel Kahnemann (of Thinking Fast and Slow) warns of our tendency to take the easier route; to treat someone by the book (or, in this case, by the Diagnostic and Statistical Manual of Mental Disorders) rather than to explore individual factors that may yield a better understanding and more helpful recommendations for treatment and recovery. While diagnoses have their uses (they are needed for access to benefits, services etc. and some people find them helpful), their over-use may hinder rather than help. Instead, we may need to consider a shift from using the predominant medical models that seek to cure individuals by targeting ‘disorders’ and instead look to the interplay of psychosocial and environmental determinants that contribute to issues such as low mood and anxiety.

Finally, should you wait for a diagnosis? Except, it’s not about literally waiting for a diagnosis – that’s misleading. Relatively speaking, giving a diagnosis takes no time at all. The subtext is that you are waiting for the issues you are experiencing to potentially worsen – to worsen to the extent that you feel you have to visit a doctor who may well give you a diagnosis in order to give you support and treatment options.

There has never been a better time to seek support for your mental health. Despite the burden the NHS is under, we are making progress. Doctors have a better understanding than ever of what it means for their patients to experience difficulties with their mental health. Research is constantly building on what we know and how to improve our services. Conversations about mental health are becoming more mainstream and, as a result, much of the stigma is on its way out. Techniques such as mindfulness and meditation are increasingly used to calm a busy mind in a busy world. So hopefully you will agree with me that, all in all, it is not worth the wait.

With big thanks to Alex Macdougall (Inclusive Growth Analysis Unit) and Leanne Cook (@leannevcook, Cognitive AppRoaches to coMbatting Suicidality) for their very helpful comments on an earlier draft of this blog piece.

Hannah Long

PhD student at the Manchester Centre for Health Psychology

@hannahlong_hl